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General NPI Number Information
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NPI Number | 1467497081
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Entity Type | Organization
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Legal Business Name | PIEDMONT TRIAD ANESTHESIA, PA
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 145 KIMEL PARK DR SUITE 120
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-6983
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Country | US
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Telephone | 336-768-3212
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Fax | 336-768-9019
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Provider Business Mailing Address
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Address Line | 145 KIMEL PARK DR SUITE 120
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6983
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Country | US
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Telephone | 336-768-3212
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Fax | 336-768-9019
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | THOMAS LUKISH III
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Credential |
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Telephone | 336-768-3212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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